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The Most Underrated Doctor's Visit: the Preconception Consult

Preconception consults are visits to your provider when you tell them that you plan to get pregnant in the near (or far) future. Your provider will make sure that your health is optimal to conceive. Pretty much any provider can do a preconception consult, but most commonly, it is your family doctor, your primary care provider, or your gynecologists.

If you have any possibility of having a high risk pregnancy, then the most important person you need to see is a Maternal Fetal Medicine specialist. Yes, that is me!

Not all preconception consults need an MFM. If you are unsure, start with your primary care provider and go from there.

If you are 25 years old with no medical issues, then an MFM will have nothing more to say than a family doctor, and in this case, an MFM consult may not be appropriate.

But if you are a 25 year old with no medical issues, and a history of a 20 week miscarriage, then an MFM consult is absolutely indicated.

What to expect at your preconception consultation visit

  1. Full history: including obstetrical history, gynecologic history, medical history, surgical history, social history, family history, genetic history.

  2. Physical exam, sometimes. Most of the time, this is not required. *this makes telehealth a great option for preconception consults*

  3. Discussion of risks: maternal and fetal risks.

  4. Optimization of health. Weight modification, dietary modification, exercise recommendations. Most importantly, seeing all the necessary specialists as needed. For example, if you have a heart condition, seeing a cardiologist is a must.

  5. Review all medications and herbal supplements, doses, and compatibility with pregnancy.

  6. Baseline labs and imaging work-up, as needed.

  7. Recommendations:

  1. If you are a candidate for pregnancy or not

  2. If you are a candidate for a vaginal delivery or not

  3. If you are a candidate for an epidural

  4. If you are a candidate for breastfeeding (this can depend on your specific condition or the medications you are on)

  5. Will you have more ultrasounds than a low risk pregnancy? If so, what kind of ultrasounds and how frequently?

  6. Recommended timing of delivery. Will you make it to your due date?

  7. Any option to lower risks with weight loss, medication changes.

Real-life examples of preconception consults

- 30 year old, no prior pregnancies, born with a heart defect that was surgically repaired

- 29 year old, 2 prior pregnancies, recently diagnosed with lupus, on medications

- 40 year old, 1 prior pregnancy 10 years ago, now advanced maternal age

- 21 year old, no prior pregnancies, von Willebrand disease

- 24 year old, 1 prior pregnancy, history of preeclampsia with severe features requiring delivery at 29 weeks

- 32 year old, no prior pregnancies, carrier of fragile X mutation

- 34 year old, 1 prior pregnancy, history of miscarriage at 18 weeks

- 39 year old, no prior pregnancies, infertility, obesity, chronic hypertension

- 36 year old, 5 prior pregnancies, prior child with trisomy 21 (Down syndrome)

- 35 year old, 3 prior pregnancies, deliveries all occurred between 30-34 weeks

- 40 year old, no prior pregnancies, history of breast cancer

- 26 year old, 4 prior pregnancies, history of Crohn disease, multiple prior surgeries

As I always recommend, bring a list of questions. Brainstorm with your partner or friend.

A list of questions to ask your doctor to get you started can be found here and here.

Are you still confused if you need a preconception consult or not? The answer is usually yes, but if let me know your story below and I will let you know my thoughts!

#maternalfetalmedicine #preconception #preconceptionconsult #highriskpregnancy

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